Attacks Of Acute Otitis Media Research Articles

The Relation Between Vitamin D Level with Acute Otitis Media and its Recurrence in Children, Aden, Yemen

Background: Acute otitis media are most common pediatric diseases. Lack of vitamin D is a risk of otitis media and its recurrences. Objective: To investigate the relation between vitamin D level and otitis media and its recurrences. Materials and method: This retrospective study conducted in Aden, between January 2019 and December 2020. Results: Eighty-five children with otitis media were studied and they were (51.8%) males and (48.2%) females. The mean age of patients was 5.6 ± 2.8 years. Most of the patients (56.5%) were between 1 to 5 years old. Fever represented (56.5%) in the age group 1 – 5 years old. The difference between values is statistically significance (p = 0.000). In the age group 1-5 years we found congested hyperamic tympanic membrane (43.5%) followed by the bulge tympanic membrane (9.4%). Highly significant differences found between otoscopic findings and the age groups (p = 0.000). Recurrent attack of acute otitis media seem to be higher in the age group 1 – 5 years old; (p = 0.041). Most (82.3%) of the patients had deficient vitamin D level followed by patients with insufficient vitamin D level (11.8%). The recurrent attacks in the deficient group represented with 3 times (30.5%) followed by 4 times (22.4%). Highly significant differences were found between recurrent attacks and level of vitamin D (p = 0.000). Conclusion: Our study showed relation between abnormal level of vitamin D and recurrent acute otitis media mostly in the age group from 1-5 years. Keywords: Relation, vitamin D, otitis media, children.

Comparison of Hearing Outcomes in Patients Undergoing Type I Tympanoplasty With Temporalis Fascia Vs Tensor Fascia Lata Graft

Background: Mucosal type of chronic otitis media is a condition characterized by a central perforation of the tympanic membrane with or without ossicular chain involvement. The perforation is in the pars tensa, and is mostly sequelae to an earlier attack of acute otitis media. The tympanic membrane perforation may be caused by chronic suppurative otitis media (CSOM) or following trauma, mostly resulting in hearing loss. Aim: To compare the hearing outcome in patients undergoing type one tympanoplasty using temporalis fascia versus patients undergoing type one tympanoplasty using fascia lata graft. Method: Patients with mucosal chronic suppurative otitis media were chosen from the OPD or outpatient department of otorhinolaryngology at Dr. DY Patil Hospital; between May 2019 and April 2021. This prospective study includes 50 patients out of which 25 patients were operated for myringoplasty with temporalis fascia and other 25 patients were operated for myringoplasty with fascia lata graft. Pre-operative and post-operative hearing assessment was done by audiometry (AB gap) and improvement in PTA findings were compared. Results: There is a significant improvement in AB gap in patients undergoing type one tympanoplasty with tensor fascia lata as compared to those who underwent the same surgery but with temporalis fascia. Conclusion: As observed by our study, significant improvement in AB gap in patients undergoing type 1 tympanoplasty with tensor fascia lata as compared to those who underwent the same surgery but with temporalis fascia was present. Thus, it can be suggested to perform type one tympanoplasty with tensor fascia lata for better improvement in AB gap.

Effect of Vitamin-D Supplementation on Recurrence of Acute Otitis Media in Pre-School Children

Background: Acute Otitis media (AOM) and its recurrence is a prevalent health problem among pre-school children. Different strategies to prevent recurrent have been established with questionable efficacy. Vitamin D is suspected as a possible preventable risk factor. Aim of the work:To evaluate the effect of vitamin-D supplementation on recurrence rate of acute otitis media among Pre-school children. Patients and Methods:60 pre-school children with a recurrent episode of acute otitis media [by history and otoscopic examination] were included. After diagnosis, all children received standard treatment and after recovery, serum levels of vitamin-D were estimated; those with reduced vitamin D had been included, then divided into: Study group (30 children, received oral vitamin-D supplementation for 4 months; and Control group (30 children; received placebo). New attacks of AOM had been document during the regular visits for the six months. Vitamin D had been re-estimated after 6 months. Results: Both groups were comparable regarding studied variables at the start. Upper respiratory tract infection and ear discharge significantly decreased; vitamin D significantly increased among study group at 6 months. Recurrent AOM after 6 months, had been significantly reduced among study vs control group (1.43±0.62 vs 3.46±0.62 respectively). Also, vitamin-D significantly increased at the end in study vs control group (21.76±5.95 vs 14.53±4.73 ng/ml respectively). The mean percentage of increase of vitamin-D in study group was 135.98% compared to 33.91%. In control group. Conclusion: Vitamin D supplementation to children with a history of rAOM plays a significant role in reduction of attack frequency.

Vitamin D levels in children diagnosed with acute otitis media

ObjectiveTo investigate the relationship between acute otitis media (AOM) and vitamin D level in children.Patients and methodsThis prospective study was conducted at Assiut University Hospital between December 2016 and March 2017. The study group comprised ambulatory children who were diagnosed with AOM and healthy controls. The blood sample (5 cm) was taken immediately after the diagnosis of AOM in the laboratory for measuring serum 25-hydroxyvitamin D. Abnormal value=deficiency+insufficiency.ResultsOf the 40 children included in this study, 30 were the cases and 10 were controls. The mean age of the cases was 4.92±3.08 and 5.92±4.04 years for the controls besides 18 (60%) of the AOM group were boys and 12 (40%) were girls, compared with five (50%) boys and five (50%) were girls in the control group. Otalgia and congested tympanic membrane were present in all children of the diseased group. Also 70% had upper respiratory tract infection preceding the attack of AOM and 33.3% had previous attack of AOM. Twenty-two (73.3%) out of 30 children of the AOM group have an abnormal value of vitamin D and it was statistically significant than the control group.ConclusionBoth vitamin D deficiency and insufficiency were significant in children suffering from AOM than normal children.

Risk factors of acute otitis media among children in Mosul

Context: Acute otitis media (AOM) is the most frequent diagnosis in the children visiting offices. The prolonged and recurrent episodes of AOM may lead to hearing impairment and delayed speech development, which will influence the child's performance at school. Aim: The aim of this study is to identify the risk factors of acute otitis media in preschool children attending ENT clinics at Al-jamhory Teaching Hospital in Mosul. Methods: To achieve this aim, a case control study design was adopted. The sample of the present study included 150 children (cases) who have been diagnosed by the responsible ENT specialist according to the otoscopic examination with another 150 children (controls) who were diagnosed not to have AOM. Period of data collection was from 1st of October 2011 to the 1st of April 2012. Results: The present study showed that the highest frequency of acute otitis media occurred in the age group 1-2 years 39 patients (26%), and more frequent AOM attacks occurred in males. Clinical presentation among the cases were fever, otalgia, otorrhea, irritability, loss of appetite, vomiting, diminished hearing, and few patients presented with tinnitus and vertigo. The significant risk factors for AOM were day care attendance, bottle feeding for the 1st 6 months of life, supine bottle feeding, pacifier use in the second 6 months of life, parental tobacco smoking, preterm baby, and allergy. No association was found between craniofacial anomaly and occurrence of AOM in the present study. Conclusion: Day care attendance, bottle feeding during the 1st 6 months of life, supine bottle feeding, pacifier use in the second 6 months of life, parental tobacco smoking, preterm baby, and allergy were found to be a significant risk factors for AOM among study population. Recommendation: Additional studies on potential measures to prevent AOM through the reduction of risk factors are needed..

Effectiveness of pandemic influenza A/H1N1 vaccine for prevention of otitis media in children

Our aim was to evaluate effectiveness of pandemic influenza A/H1N1 vaccine in preventing acute otitis media (AOM) and/or otitis media with effusion (OME), in a randomized, prospective and single-blind study conducted in the children aged of 6-60 months. This study was done between December 1, 2009 and April 30, 2010 during the pandemia between June 2009 and May 2010. On the healthy children, vaccinated against pandemic influenza A/H1N1 and age-matched unvaccinated controls, the rate of AOM, OME, and any otitis media (OM) attack (sum of AOM and OME attacks) confirmed by otoscopic and tympanometric examination, and their associations with risk factors were looked for. Otoscopic and tympanometric evaluation was done twice within the follow-up period of 4-8 weeks. Totally 46 vaccinated and 46 unvaccinated healthy children were enrolled. No difference in rates of AOM, OME, or OM was found between vaccinated and unvaccinated children. But logistic regression analysis revealed that unvaccinated children had 2.9-folds more risk for OME and OM, but not for AOM. Further, male gender and bottle feeding and/or using pacifier revealed significant relationships with AOM. We conclude that pandemic influenza A/H1N1 vaccine prevented OME rather than AOM attacks in children with 6-60 months of age.

Nasopharyngeal dimensions in magnetic resonance imaging and the risk of acute otitis media

We have previously found by lateral cephalometry an association between nasopharyngeal anatomy and the risk of acute otitis media (AOM). We evaluate here the association of nasopharyngeal dimensions in magnetic resonance imaging (MRI) with the occurrence of AOM in otherwise healthy children. Sixty-one healthy children (mean age 5.7 years, range 3.9-6.9) were recruited from child care centres. The parents filled in a questionnaire on the child's history of ear infections and adenoidectomy. MRI was performed with a 4 mm slice thickness during an upper respiratory infection. Five dimensions and two angles expressing the structure of the bony nasopharynx were measured in sagittal images. The dimension from the caudal edge of the septum to the midpoint of the sella, reflecting the height of the nasopharynx, was on average 2.2 mm smaller in the children who had had AOM attacks during the last 12 months than those without attacks (95% confidence interval (CI) 0.9 to 3.4, p=0.001) and the nasal base angle was on average 2.1 degrees smaller (95% CI 0.7 to 3.5, p=0.004). These differences remained significant after adjustment for age, sex and previous adenoidectomy in the logistic modelling. A history of adenoidectomy did not have any effect on the dimensions. The nasopharynx was smaller in the children with AOM attacks during the last year. The value of this finding for predicting susceptibility to recurrent AOM and directing preventive procedures should be evaluated.

Risk factors for otitis media with effusion in Chinese schoolchildren: A nested case–control study and review of the literature

To identify the risk factors for otitis media with effusion (OME) in Chinese schoolchildren and analyse the results with reference to the review of the literature. The study subjects were 6-7-year-old children drawn from a school-screening program for OME in Hong Kong. Both positive and negative screens attended a hospital clinic for further assessment with repeated otoscopic examination and tympanometry as well as pure tone audiometry within 3 weeks after the initial school-screening. During the visit, parents were interviewed to provide information with regard to the children's birth history, neonatal history, socio-economic background, otological history, past health, and medical history. These data formed the basis in the estimation of potential risk factors for OME. In the univariate analysis of 127 cases and 173 controls, significantly elevated odds ratios (OR) for OME were detected on the symptoms of atopy (OR = 2.21, p = 0.04), hearing loss (OR = 4.13, p = 0.001), nasal obstruction (OR = 1.94, p = 0.005), rhinorrhoea (OR = 1.61, p = 0.04), tonsillitis in the past 12 months (OR = 1.82, p = 0.02), and previous history of acute otitis media (OR = 6.89, p < 0.001). However, only three of them were found to be significant in the multivariate logistic regression model: nasal obstruction (OR = 1.67, 95% CI: 1.01-2.75); acute tonsillitis (OR = 1.68, 95% CI: 1.00-2.80), and previous acute otitis media episodes (OR = 5.75, 95% CI: 2.60-12.69). Risk factors identified in the Chinese schoolchildren for OME were comparable with previous western reports. A previous attack of acute otitis media was a major determinant for middle ear effusion.

Alteration of clinical picture and treatment of pediatric acute otitis media over the past two decades

The clinical picture of acute otitis media (AOM) has changed greatly over the last few decades: serious complications have almost disappeared but more and more children suffer from recurrent middle ear infections and prolonged silent effusion. In this retrospective study we registered all AOM attacks among children under 10 in two rural municipal areas of Finland during 12-month-periods in 1978–79 and 1994–95. In addition to epidemiological data, the clinical picture and given treatments were recorded. Between study periods the number of children with recurrent AOM attacks increased heavily. The percentage of spontaneous otorrhea decreased from 6.0 to 3.3% ( P=0.01) and the proportion of afebrile patients increased from 64.0 to 73.4% ( P=0.002). In 1978–79 there were significantly more cases of diagnostic symptoms lasting over 24 h. Prescribing penicillin-V as a primary treatment decreased from 80.2 to 10.5% in favor of broad-spectrum antibiotics. The primary treatment with penicillin-V was associated with a decreased risk of recurrences. Acute tympanocentesis was performed less often and the incidence of surgical treatments (adenoidectomy and/or tympanostomy tube insertion) doubled from 6.2 to 12.4% of the acute cases. Although the clinical picture of AOM has become milder, children are treated with wider spectrum antibiotics. Nevertheless, a large number of children suffer from sequelae and there is a greater need for surgical treatments than 20 years ago.

Costs arising from otitis media.

Otitis media (OM) is one of the most common diseases of childhood, and causes both direct and indirect costs to families and to society. This study calculated the costs arising from OM among 736 day care children whose infections were prospectively monitored for up to 15 mo in 10 day care centres in the city of Oulu. The children in the survey had 1.5 attacks of acute OM per person year, made 2.1 visits to a physician (cost $US55 visit(-1)) and received 1.5 courses of antimicrobials (cost $24 course(-1)). Their parents were absent from work for 1.9 d per person year (cost $85 d(-1)). Either adenoidectomy ($890 operation(-1)) or tympanostomy ($740) was performed on 6% of the children and the overall costs of surgery were $80 per person year at risk. In total, each single attack of acute OM cost $228. The average annual costs per child younger than 2 y were $1040, those for children aged 2-3 y $283 and those for children older than 3 y $141. The cumulative costs from age 6 mo to 7 y were $2549 child(-1). When the attributable risk of OM at a day care centre is taken into account, in Finland, a country with about 5 million inhabitants, OM gives rise to total annual costs of $US138 million. OM leads to considerable expenses and even expensive preventive measures would be cost-effective.

Immunization and protection in pneumococcal otitis media studied in a rat model.

The recent and growing problem of bacterial resistance to common antibiotics has generated great interest in different methods for prevention of infections. The treatment of the pathogens causing upper airway infections and especially acute otitis media (AOM) is especially interesting in this context because these infections are a common cause of prescription of antibiotics all over the world. Both in AOM and recurrent AOM, Streptococcus pneumoniae, the most frequently occurring bacterium is isolated in 30-50% of all AOM attacks. In the last decade, multiresistant S. pneumoniae have emerged as a major problem. Thus, it is important to explore possibilities that immunization may protect against pneumococcal OM. In a well-defined animal model using Sprague-Dawley rats, we have investigated the effects of different routes of immunization with different antigens and whole cells. Together with otomicroscopical evaluation of middle ear (ME) status, samples for bacterial cultivation as well as for studies of histopathological changes have been collected. Antibody titers have been followed during and after pneumococcal AOM by an enzyme-linked immunosorbent assay (ELISA) method.

Increase in paediatric acute otitis media diagnosed by primary care in two Finnish municipalities--1994-5 versus 1978-9.

In recent decades, several epidemiological studies have been published on acute otitis media (AOM), indicating that the occurrence of AOM is increasing. However, the comparison between the surveys is complicated and biased by several factors, e.g. variable study demography and design and dissimilar diagnostic criteria. The present study was performed with an identical set-up in 1978-9 and 1994-5 to find out potential changes in the occurrence of AOM. All the attacks of AOM among children under 10 years diagnosed by a physician during the 12-month periods 1 June, 1978 to 31 May 1979 and 1 June 1994 to 31 May 1995 were registered retrospectively in two Finnish municipalities. The incidence rate (total number of AOM attacks per 100 child years) was 19 (95% CI 18-21) in 1978-9 and 32 (95% CI 30-34) in 1994-5. The increase in the occurrence of AOM was 68% (95% CI 53-79%, P < 0001).

Otological problems in children with Turner's syndrome

Ear and hearing disorders are common problems among girls and women with Turner's syndrome. During infancy and childhood the girls often suffer from repeated attacks of acute otitis media and later in life the women frequently complain of a rapid onset of social hearing problems due to sensorineural hearing impairment. A study of 56 girls aged 4–15 years with Turner's syndrome was performed to investigate the prevalence of eardrum pathology and hearing impairment in young children and teenagers with Turner's syndrome. A possible relation to karyotype was also investigated. A high prevalence (61%) of recurrent acute otitis media was found in the study group and 32% had been treated with ventilation tubes. Fifty-seven percent showed eardrum pathology, such as effusion, myringosclerosis, atrophic scars, retraction pockets and perforations. Auricular anomalies were noted in 23% of the cases, most commonly in the 45,X group. The audiometric analysis showed conductive hearing loss (air–bone gap>10 dB HL) in 43% and the typical sensorineural dip in the middle frequencies was found in 58% of the girls, of whom the youngest was 6 years old. Four percent were using hearing aids. The data of this study further confirm that the dip is progressive over time and may be detectable as early as at the age of 6, giving a chance to predict a future hearing loss. The findings emphasize the importance of regular otological examinations and audiological evaluations of all girls with Turner's syndrome early in life.

Do seasonal priming effects in the first months of life influence development of middle ear disease?

A history of acute otitis media (AOM) often precedes development of otitis media with effusion (OME); where that history pre-dates the first birthday an increased risk has been demonstrated previously. The possibility of establishing a critical period of susceptibility to the priming attack of AOM is explored using a large national database. The complete GP histories of 7510 children born in the year beginning October 1989 and followed until their fifth year of life, within practices representative of England and Wales, permit examination of the following risk factors: history of asthma, eczema and hayfever; type and timing of all middle-ear-related conditions; upper respiratory tract infections; reported snoring; sex. The following risk factors were confirmed: sex, atopy (in particular hayfever), nose, chest and throat infections (particularly chest), and reported snoring. Age of first attack of AOM was the strongest indicator of subsequent OME. Risk decreased with increased age. Different age groups were examined in 3-month bands and a critical period could be detected covering the first 9 months of life. Risk of subsequent OME varied slightly by season of first AOM, particularly within the critical period. Children born in spring appeared to be at highest risk.

Extended High Frequency Hearing and History of Acute Otitis Media in 14-Year-Old Children in Finland

We studied the extended high frequency hearing of 573 white, urban, mean 13.8-year-old unselected children in Tampere, Finland. All their ear-related morbidity had been recorded since their birth and they had been examined at the ages of 7 months, 2 years, and some of them at 5 years. The extended high frequency audiometry was measured from 10 to 18 kHz, with 1 kHz steps, and the results were related to the number of attacks of acute otitis media (AOM) (0, 1–2, 3–7 and ≥8) they had experienced. The mean pure tone hearing thresholds varied from 10.7 dB at 10 kHz to 37.0 dB at 18 kHz in the right ears and between 11.6 dB at 10 kHz and 37.4 dB at 18 kHz in the left ears. Among those with ≥8 attacks of AOM the thresholds were highest, the difference between them and each of the first 3 groups being statistically significant at 13 and 14 kHz. From 11 to 16 kHz the same difference was significant between the last (≥8 AOM) and at least 2 of the first 3 AOM groups. Numerous attacks of AOM may have a harmful effect on high frequency hearing in the long term.

Bacteriological Findings and Persistence of Middle Ear Effusion in Otitis Media with Effusion

The bacteriology of middle ear effusion (MEE) of asymptomatic otitis media with effusion (OME) was studied in 165 children, aged 5 months to 12 years, from the MEE samples obtained during tympanostomy under general anaesthesia in 1993–1994. MEE had persisted for 1 to 12 (mean 3.5) months. Major otitis pathogens (S. pneumoniae, H. Influenzae, B. catarrhalis and S. pyogenes) were cultured in 41% of the children under 2 years of age and in 17% of older children (p < 0.001). Respiratory infections and attacks of acute otitis media (AOM) during the last 6 months were also more frequent in children younger than 2 years (p < 0.001). The proportion of S. pneumoniae (25%) and H. influenzae (38%), but not of other bacteria, was higher in the children with less than 2 months' persistence of MEE as compared with those with a longer duration (8% and 3%) (p<0.01). After 2 months, the occurrence of different bacteria remained relatively unchanged until 6 months' persistence of MEE, and thereafter no pathogens were culturable. Among the children adenotomized earlier, the proportion of those with major otitis pathogens in MEE was 8% compared with 32% in non-adenotomized children (p = 0.02). S. pneumoniue, B. catarrhalis or S. pyogenes were not culturable in any of the adenotomized children, while MEE grew them in 25% of the non-adenotomized children (P < 0.001). Since the MEE bacteriology of OME with less than 2 months' persistence resembles that of AOM, it may be that these cases represent a transitory phase between AOM and an established OME.

Frequency and Risk Factors of Infantile Acute 0titis Media

To find out the frequency and risk factors of infantile acute otitis media (AOM) in Ankara; computerized patient data from a pediatrician's private practice were evaluated retrospectively. 106 attacks of AOM in 70 of 442 infants were evaluated and compared with 55 healthy control infants who had experienced no AOM attacks in their first year of life. The attack rate of AOM in the first year of life was about 24 percent; 15.8% (70 of 442) of the infants had had AOM, it being more frequent, in the second half of the first year, irrespective of sex. With the exception of summer, when the incidence is low, AOM struck with almost the same frequency in other seasons. 27 of the 70 infants (39%) with AOM were exclusively breast-fed, which was significantly less than the controls (76%); 49 of them (70%) were exposed to passive smoking, compared with only 31% of the control infants (p

A Pacifier Increases the Risk of Recurrent Acute Otitis Media in Children in Day Care Centers

To follow up a previous retrospective analysis in which we found the use of a pacifier to be a risk factor for recurrent acute otitis media (AOM). In the present prospective study, the occurrence of AOM and the use of a pacifier were recorded in 845 children attending day care centers during a 15-month period. More than three attacks of AOM occurred in 29.5% of the children younger than 2 years using pacifiers and in 20.6% of those not doing so (relative risk, 1.6; 95% confidence interval [CI], 0.6, 4.1); in children 2 to 3 years of age, the figures were 30.6% and 13.2%, respectively (relative risk, 2.9; 95% CI, 1.2, 7.3). Logistic modeling with adjustment for age and the duration of monitoring showed the occurrence of AOM to be associated with the time during which a pacifier was used. The use of a pacifier increased the annual incidence of AOM from 3.6 (95% CI, 2.5, 4.9) to 5.4 episodes (4.4, 6.6) in children younger than 2 years and from 1.9 (1.4, 2.5) to 2.7 (2.2, 3.3) in children 2 to 3 years of age. The population-attributable risk of AOM attacks due to the use of a pacifier was 176 attacks, ie, 459 to 635 attacks per year, in the youngest children and 69 attacks, ie, from 264 to 333 attacks per year, in those 2 to 3 years of age. It can be calculated that the use of a pacifier was responsible for 25% of the attacks in children younger than 3 years. Breastfeeding, parental smoking, thumb sucking, using a nursing bottle, and the social class of the family failed to show such strong associations with the occurrence of AOM. We conclude that the use of a pacifier is a significant risk factor for recurrent AOM and suggest that pacifiers should be used only during the first 10 months of life, when need for sucking is strongest, and AOM is uncommon.

Hearing and acute otitis media in 13-year-old children.

Air and bone conduction thresholds of 330 unselected urban 13-year-old children with a known history of otitis were measured under ideal conditions, using standard clinical audiometry. In the subgroups of children with different numbers (0, 1-2, 3-7, > or = 8) of attacks of acute otitis media (AOM) in their history, the mean air conduction thresholds varied from 0.2 to 11.5 dB at different frequencies in different AOM subgroups. Air conduction pure tone averages (PTA, mean threshold at 0.5, 1 and 2 kHz) > 20 dB were not found in any of the ears. The mean bone conduction thresholds varied from -0.0 to 1.8 dB, depending on the subgroup and frequency (0.25 to 4.0 kHz) studied. Bone conduction PTAs > 10 dB were measured in 5 (0.8%) ears. Single bone conduction thresholds > 10 dB were found at different frequencies in 3 to 15 (0.5 to 2.3%) of the ears, and thresholds > 20 dB in only 2 ears (0.3%). The mean thresholds and number of ears with decreased hearing were distributed equally between different AOM subgroups, except that some air conduction high frequency losses were more frequent in children with > or = 8 attacks of AOM. We conclude that childhood AOM, even if it occurs frequently, seems not to have a significant harmful long-term effect on hearing.

Maternal blood group in otitis media with effusion.

Risk factors for otitis media with effusion (OME) have proved difficult to apply in selecting persistent cases, or those otherwise requiring intervention. Explanations may include low predictive values of individual factors and the costs of data collection. In this study, profiles on 225 children from conception to age 7 years were compiled from medical and Health Authority records and structured interviews with parents. On the grounds that nearly all cases receiving medical intervention after waiting and onward referral are more than transitory (although many persistent cases will not receive such attention) this was taken as the dependent variable--a marker of persistence. Established risk factors and maternal blood group A were considered singly to predict intervention, then in combination using logistic regression. Maternal blood group A gave a relative risk (RR) for intervention of 2.82. The noted occurrence of an attack of acute otitis media (AOM) before the first birthday gave a RR of 6.13. When these two factors were used together, the RR climbed steeply to 26.77. These findings suggest that further research is justified into the nature of the influence of blood group A on OME, and the use of combinations of risk factors to give enhanced prediction.